2019 yılının son aylarında başlayan yeni tip koronavirüs hastalığı-2019 (COVID-19) salgını tüm dünyada hızla yayıldı ve erişkinler başta olmak üzere çok sayıda ölüme yol açtı. Son zamanlarda ise özellikle çocuk yaş grubunda bu yeni pandemik koronavirüs etkenine bağlı olduğu düşünülen hiperenflamatuvar yanıtın neden olduğu sendromik bir durum tanımlandı. Bu yanıtın özellikle Kawasaki hastalığına benzediği ve multiorgan tutulumuyla kendini gösterebileceği belirtildi. Bu yeni klinik durum, geçici olarak ağır akut solunum sıkıntısı sendromu-koronavirüs 2 ile ilişkili pediyatrik enflamatuvar multi-sistem sendrom veya COVID-19 ile ilişkili çocukluk çağı multi-sistem enflamatuvar sendrom olarak tanımlandı. Bu sunumda acil servisimize Kawasaki hastalığına benzer şikayetlerle başvuran dokuz yaşında erkek bir hasta anlatıldı. Hasta hipotansiyon, myokardit, olası makrofaj aktivasyon sendromu ve eş zamanlı COVID-19 pozitifliği nedeniyle çocuk yoğun bakım ünitemizde takip edildi. Kawasaki hastalığı için intravenöz immünoglobülin, asetilsalisilik asit, düşük molekül ağırlıklı heparin ve metilprednisolon, myokardit için enalapril ve furosemid, COVID-19 için favipiravir kullanıldı. Olgumuzu çocuk hastalarla uğraşan klinisyenlere örnek teşkil edebilmek ve dünya çapındaki tüm çocuklarda COVID-19’un daha kolay tanınması, önlenmesi, teşhisi ve tedavisi için yardımcı olabilmek adına sunmak istedik.

A new type of coronavirus disease-2019 (COVID-19) epidemic, which started in the last months of 2019, has spread rapidly all over the world and caused many deaths, especially in adults. Recently, a syndromic condition caused by the hyperinflammatory response that is thought to be due to this new pandemic coronavirus factor has been identified, especially in the childhood age group. It has been stated that this response is particularly similar to Kawasaki disease and can manifest itself with multiorgan involvement. This new clinical condition was defined as pediatric inflammatory multi-system syndrome temporally associated with severe acute respiratory syndrome-coronavirus 2 or multi-system inflammatory syndrome in children associated with COVID-19. In this case presentation, a nine-year-old male patient was admitted to our emergency department with complaints similar to ones in Kawasaki disease. The patient was followed up in our pediatric intensive care unit due to hypotension and myocarditis, as well as likely macrophage activation syndrome and simultaneous COVID-19 positivity. For Kawasaki disease, intravenous immunoglobulin, acetylsalicylic acid, low molecular weight heparin and methylprednisolone; for myocarditis, enalapril and furosemide; and for COVID-19, favipiravir was administered to the patient. We would like to present our case to exemplify clinicians dealing with pediatric patients and to assist in easier recognition, prevention, diagnosis and treatment of COVID-19 in all children worldwide.

The new type of coronavirus epidemic that started in the People’s Republic of China in December 2019 turned into a pandemic in March 2020 and, affected many pediatric patients. 2% of the cases in the Republic of China were pediatric patients. Although the symptoms such as headache, sore throat, myalgia, loss of sense of smell and taste, diarrhea are also seen, the most common symptoms of the infection are fever, cough and dyspnea. The disease may progress in a wide range from asymptomatic cases to severe respiratory failure accompanied by pneumonia and death. The incidence of critically ill children is reported as 11%. The World Health Organization reported that of cases diagnosed with COVID-19, critically ill patients are more likely to have myocarditis, Kawasaki syndrome or multiple systemic inflammatory syndrome (MIS-C). In this article, 4-month-old infant with respiratory failure who presented with respiratory failure on 30 March 2020, was diagnosed with severe COVID-19 pneumonia and myocarditis, and treated with the algorithm recommended by Republic of Turkey Ministry of Health, is presented.